Billing

Billing

Co-pays are due and payable at the time of visit.

After each appointment, we will submit all charges to your insurance for payment. Once payment has been received, you will receive a billing statement from our office indicating whether any remaining balance is due.

Insurance companies will deny payment if any information is not current. They will also deny payment if information is not submitted correctly within a certain amount of time. Please notify us of any changes in insurance, address or phone numbers.

You are ultimately responsible for all charges incurred regardless of insurance payment.

For any billing questions, please email billing@coastpediatrics.com.

Billing Frequently Asked Questions

I received a letter from Anthem Blue Cross stating that I need to get pre-authorization for my child’s well check before my visit.  Is this true?

Yes.  For well visits over the age of 5, parents must contact Blue Cross using the 800 number on your insurance card.  Tell Blue Cross that your child will be seeing us for a well care visit.  Blue Cross will provide you with an authorization form that you must bring to the visit with you, and we will then submit the authorization to the insurer with our claim.   Cumbersome, but necessary as required by the insurer for proper payment.

Why does my billing statement show two flu tests being performed and billed on the same day?

The flu test that we use in our office is able to test for and differentiate between the two strains of Influenza (A and B).  Proper coding and billing for this test involves submitting the same code twice, with an extra “modifier” on one of the test codes.  

Why do I receive a bill for some of my child’s visits while others seem to be covered fully by my insurance?

Every insurance contract and plan is unique in the coverage that it offers.  When we submit our bill to your insurer, the insurer “adjusts” the charges based on the agreed upon rates of our contract with them, and the details of their contract with you.  Some plans require that families meet a predetermined deductible before the insurance pays for any charges.  Other plans will have different “rules” for well care, sick visits, laboratory testing, etc.  We review all statements before sending them to you in order to try to assure that your insurance has treated the charges properly.  If you feel that any charges have been adjusted incorrectly by your insurance you may contact our billing office for assistance, or you may contact your insurer directly.  We will be happy to try to help resolve such issues in any way that we can.

How do I read my statement?

Your statement contains charges broken down into claims.  On the left side is information about the claim itself such as date of visit, physician seen, diagnoses and services provided.  On the right side is financial information.  You will see our charges for the services provided in the center.  “Insurance Adjustment” is the amount that the insurer has discounted our charges based on contracts (or for insurances with whom we are not contracted, based on their out of network rates).  Once the insurer has adjusted the rates, payment are either rendered by the insurance company and show as “Insurance Payments,” or assigned to the “Patient Owed” section as part of a copayment or deductible.  At times there may be an amount listed under “Patient Adjustment,” which represents any adjustment by our office to the charges.  Under “Patient Payment” is any amount that you have paid that has already been applied, such as a co-pay or a remaining credit from a prior payment.  Finally, “Family Balance Due” is the difference between “Patient Owed” and “Patient Payments”–this represents the portion of the services that you are responsible for paying and is payable at the time of the statement.  Payments can be made on our patient portal, by check, or by credit card in the office or over the phone.  Our billing office is happy to help you navigate this often confusing world of medical insurance reimbursement!